Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Clin Microbiol Infect. 2020 Jul;26(7):864-870. doi: 10.1016/j.cmi.2019.10.024. Epub 2019 Nov 1.
Coxiella burnetii, the causative agent of Q fever, causes abortions in animals. Its effects on pregnancy in humans and the management of Q fever in pregnancy are uncertain.
To summarize data on the effects of Q fever on pregnancy in women, the effects of pregnancy on Q fever complications and the optimal screening and management of Q fever during pregnancy.
We searched for studies reporting on Q fever during pregnancy in women. We included randomized and observational studies, seroprevalence studies, case series and case reports, including clinical and histopathological studies.
The accumulating data seems convincing that Q fever increases the risk of abortions in early pregnancy and prematurity or intrauterine fetal demise in late pregnancy. Data are based on sero-epidemiological associations of Q fever and adverse pregnancy outcomes and case reports showing the presence and effects of C. burnetii on the placenta and the fetus. Based on observational studies, acquisition of Q fever during pregnancy also increases the risk for maternal chronic Q fever. Treatment of recently infected women seems to improve these outcomes, based on case series only, but the optimal duration of treatment has not been studied. The efficacy of active surveillance during pregnancy, timing and frequency have not been determined in high-endemicity settings. Obstetricians should be aware of the risk for transmission of the disease during delivery. Currently available data are based mostly on case series and case reports, with some discrepancy between the French experience in chronic endemicity settings and Dutch experience in outbreak settings.
Since infection with Q fever is largely asymptomatic, we believe that the accumulating information linking Q fever to adverse pregnancy outcomes justifies screening in the high-endemicity setting and treatment of infected women. High-quality research addressing the questions raised by this review is needed to determine the optimal public health policy.
贝氏柯克斯体是 Q 热的病原体，可导致动物流产。其对人类妊娠的影响以及妊娠期间 Q 热的管理尚不确定。
总结 Q 热对孕妇妊娠的影响、妊娠对 Q 热并发症的影响以及妊娠期间 Q 热最佳筛查和管理的数据。
我们检索了关于孕妇 Q 热的研究。我们纳入了随机和观察性研究、血清流行病学研究、病例系列和病例报告，包括临床和组织病理学研究。
越来越多的数据表明 Q 热会增加早期妊娠流产、晚期妊娠早产或宫内胎儿死亡的风险。这些数据基于 Q 热与不良妊娠结局的血清流行病学关联以及显示胎盘和胎儿存在并受 C. burnetii 影响的病例报告。基于观察性研究，妊娠期间感染 Q 热也会增加母亲慢性 Q 热的风险。仅基于病例系列研究表明，治疗近期感染的女性似乎可以改善这些结局，但尚未研究最佳治疗持续时间。在高流行地区，妊娠期间主动监测的效果、时间和频率尚未确定。妇产科医生应该意识到在分娩过程中传播疾病的风险。目前可用的数据主要基于病例系列和病例报告，法国在慢性地方性流行环境中的经验与荷兰在暴发环境中的经验之间存在一些差异。
由于 Q 热感染在很大程度上无症状，我们认为将 Q 热与不良妊娠结局联系起来的累积信息证明了在高流行地区进行筛查和治疗感染女性是合理的。需要进行高质量的研究来解决本综述提出的问题，以确定最佳的公共卫生政策。
